Venous leak and direct stimulation questions

First of all thanks to the many posters; this is by far the best collection of Venous Leak discussions I've found online.

My story:

52 years old
Never smoked
Occasional light drinker
No prescription meds except Levitra
Daily 80mg aspirin, fish oil and multivitamin
Currently about 15lbs overweight on my way back to target
No history of high blood pressure or high cholesterol
Gradual evolution into ED over the past 8 years
First started using PDE5 inhibitors 5 years ago
Viagra never worked
Cialis provided some help
Levitra worked well for the first two years then gradually lost effectiveness
20mg Levitra now provides all the side effects
(stuffy head, headache, face flush) but few of the benefits

With constant direct stimulation I can usually get a good erection
Within seconds of stopping direct stimulation I lose the erection
The rate of erection loss isn't affected by position (lying, sitting, standing)
I don't think I've had NPTs in years, but I haven't had the Rigiscan test to confirm
Similar erection results with partner or while masturbating
Best erections (maybe 80%) with Levitra + penis ring
Just before orgasm my erection can be quite strong
GP tested T level and found:
Total Testosterone by LCMSMS 269 Reference range: 250 to 1100 Unit: ng/dL
Free Testosterone 59.1 Reference range: 35.0 to 155.0 Unit: pg/mL
Free Testosterone 2.20% Reference range: 1.1% to 2.8%
Two Urologists diagnosed "it's all in your head" based on interview but no tests or exams

I believe I have a Venous Leak condition even though I do not yet have confirmation from a Urologist. I can confirm the experience of others that the doctors and Urologists I've talked to haven't been very helpful.

Here are my questions:

I'm skeptical, but willing to be convinced that it is 'all in my head'. Now, is there anyone out there who has had similar symptoms and diagnosis ('all in your head') who has been treated successfully by a psychologist/psychiatrist/therapist to cure the 'all in your head' dysfunction? And by successful treatment I mean treatment that has resulted in strong erections, as opposed to successful treatment to help you come to terms with not having strong erections.

Why would PDE5 inhibitors stop working? Is that an expected result? I understand that some drugs lose their effectiveness with repeated use. Has this been observed for PDE5 inhibitors? Would injections be the next step?

Why would an erection be possible with direct stimulation, but be quickly lost without it? I realize that the pipes and valves analogy isn't quite accurate, but humor me. This says that when there is direct stimulation either the supply valve is opening wider and/or the discharge valve is closing tighter than without direct stimulation. Is the round-trip to the brain involved or not? i.e. does the direct stimulation somehow result in a stronger signal from the brain to open supply and/or close discharge? Or is it a much more local effect without getting the brain involved: does the manual massage of the flat muscles somehow allow them to pass more blood, and/or more tightly constrict the discharge veins independent of communication with the brain? Suppose you wanted to find out - what possible experiment could you devise to factor out the two possible effects and figure out which was actually responsible for the erection?

My intuition, is that the direct stimulation is having some very local effect rather than involving the brain much. I'll grant that my evidence is weak: I can get an erection by direct stimulation, but no amount of mental arousal (via image, sound, smell, touch or taste) will result in an erection. This wasn't always true for me - I used to get nice stiff erections via any of my senses or even by just thinking erotic thoughts. I don't mean to say that my brain isn't involved - there's no question that my brain becomes very aroused during sex. I'm just wondering if the brain-to-erection circuit is really working as it should given that direct stimulation is a requirement for erection.

Very intresting post. Same problem over here.
Theoretically, when venous leak is present, the erection just subsides with of without direct stimulation.

I just thought this maybe could be a neurological problem. We need excessive stimulation in order to hold it up. Maybe the nerves don't give adequate signals to the penis. So more stimulation is needed. Neurological dissorders can simulate venous leak.

I'm 48, in great health and in the same boat...It's gotten to where I require constant stimulation to maintain an erection, even with ED meds. Rarely do I get an erection anymore from mental/visual arousal. It seems like any kind of mental/visual arousal effects my testicles, instead of my penis. I do believe some of this is "in my head", because many times I'll wake up at night and in the morning with a hard erection, only to lose it seconds after I awaken. I also have anxiety issues that play a large part in my ED problems and low libido. I would also like to know if anyone with this issue has had successful treatment for this type of dysfunction.